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在接受派姆单抗治疗的患者中，因不明原因穿透性主动脉溃疡行胸部分支内支架置入术后发生主动脉食管瘘。

Aortoesophageal fistula following thoracic branch endoprosthesis for cryptogenic penetrating aortic ulcer in a patient on pembrolizumab.

作者信息

Kim Sarah, Conroy Patrick D, Zemela Mark, Tjaden Bruce L

机构信息

Cooper Medical School of Rowan University, Camden, NJ.

Department of Vascular and Endovascular Surgery, Cooper University Hospital, Camden, NJ.

出版信息

J Vasc Surg Cases Innov Tech. 2025 May 29;11(4):101837. doi: 10.1016/j.jvscit.2025.101837. eCollection 2025 Aug.

DOI:10.1016/j.jvscit.2025.101837
PMID:40521387
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12166453/
Abstract

Penetrating aortic ulcers are uncommon and life-threatening. We describe the case of a 67-year-old man who presented with fever and chills and was found on computed tomographic scan to have a thoracic penetrating aortic ulcer. The patient underwent placement of a thoracic branch endoprosthesis, with a postoperative course complicated by ileocolic pseudoaneurysm, progressive aortitis, and a fatal aortoesophageal fistula. The management of penetrating aortic ulcer in the setting of multiple confounding factors is discussed in the context of this patient's complex medical presentation, with a focus on the potential role of pembrolizumab in his disease progression.

摘要

穿透性主动脉溃疡并不常见且危及生命。我们描述了一名67岁男性的病例，他出现发热和寒战，计算机断层扫描发现患有胸段穿透性主动脉溃疡。该患者接受了胸段分支血管内支架置入术，术后出现回结肠假性动脉瘤、进行性主动脉炎和致命的主动脉食管瘘等并发症。结合该患者复杂的临床表现，讨论了在存在多种混杂因素情况下穿透性主动脉溃疡的治疗，重点关注帕博利珠单抗在其疾病进展中的潜在作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/8a1a2fda4d15/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/32618b12f1d1/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/dddc8cde91d6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/4a865a5cbd72/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/8a1a2fda4d15/gr4.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/32618b12f1d1/gr1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/dddc8cde91d6/gr2.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/4a865a5cbd72/gr3.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/330d/12166453/8a1a2fda4d15/gr4.jpg

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本文引用的文献

1
A Cautionary Note on Pembrolizumab use in Patients with Ascending Aortic Aneurysms.关于帕博利珠单抗在升主动脉瘤患者中使用的警示说明。
Eur J Case Rep Intern Med. 2024 Apr 3;11(5):004419. doi: 10.12890/2024_004419. eCollection 2024.
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Failed endovascular abdominal aortic aneurysm repair due to infection following intravesical bacillus Calmette-Guérin therapy.卡介苗膀胱内灌注治疗后感染导致血管内腹主动脉瘤修复失败。
J Vasc Surg Cases Innov Tech. 2022 Nov 8;8(4):807-812. doi: 10.1016/j.jvscit.2022.10.020. eCollection 2022 Dec.
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A Case Report of Immune Checkpoint Inhibitor-Induced Aortitis Treated with Tocilizumab.
一例用托珠单抗治疗免疫检查点抑制剂诱发的主动脉炎的病例报告
Case Reports Immunol. 2022 Oct 12;2022:7971169. doi: 10.1155/2022/7971169. eCollection 2022.
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Retrospective analysis of clinical trial safety data for pembrolizumab reveals the effect of co-occurring infections on immune-related adverse events.对 pembrolizumab 临床试验安全性数据的回顾性分析揭示了合并感染对免疫相关不良事件的影响。
PLoS One. 2022 Feb 10;17(2):e0263402. doi: 10.1371/journal.pone.0263402. eCollection 2022.
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Inflammatory Thoracic Aortic Aneurysm in a Patient with Advanced Lung Adenocarcinoma Treated with Pembrolizumab.接受派姆单抗治疗的晚期肺腺癌患者的炎症性胸主动脉瘤。
Intern Med. 2022 Aug 1;61(15):2339-2341. doi: 10.2169/internalmedicine.8688-21. Epub 2022 Jan 13.
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Thoracic endovascular aortic repair for esophageal cancer invading the thoracic aorta: a questionnaire survey study.胸腔镜主动脉修复治疗侵犯胸主动脉的食管癌：问卷调查研究。
Esophagus. 2020 Jan;17(1):74-80. doi: 10.1007/s10388-019-00696-7. Epub 2019 Oct 5.
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Salvage esophagectomy combined with partial aortic wall resection following thoracic endovascular aortic repair.胸主动脉腔内修复术后挽救性食管切除术联合部分主动脉壁切除术
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Endovascular Repair of Ruptured Infected Arteries as a Temporizing Measure Versus Destination Therapy.破裂感染动脉的血管内修复作为一种临时措施与最终治疗的比较
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Endovascular treatment of mycotic aortic aneurysms: a European multicenter study.腔内治疗真菌性主动脉瘤：一项欧洲多中心研究。
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